Download Introduction to Hospital and Health

David A. Holdford, R.Ph., M.S., Ph.D., FAPhA
Associate Professor
Department of Pharmacotherapy and Outcomes Science
Virginia Commonwealth University School of Pharmacy
Richmond, Virginia
Thomas R. Brown, M.S., Pharm.D., FASHP
Professor Emeritus
University of Mississippi School of Pharmacy
Oxford, Mississippi
American Society of Health-System Pharmacists
Bethesda, MD
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<to come>
ISBN 978-1-58528-237-1
Dedications
To my love, Diane—nurse, daredevil, cowgirl.
—David A. Holdford
To my grandsons, Andrew Reaves Brown and Bennett James Brown,
and my granddaughter, Piper Mackenzie Brown.
—Tom Brown
Preface
When I was a child living in Mount Vernon, Ohio, I visited my father at his workplace in
the pharmacy of Mercy Hospital, a small catholic hospital serving the rural community.
My Dad, Arthur A. Holdford, R.Ph., was the director of pharmacy services. In fact,
he was the only pharmacist employed by Mercy Hospital at the time. Large pharmacy
staffs were not common when he first took the job at the hospital. Over time, he was
able to hire employees to support the expansion of pharmacy services.
The hospital where my father worked was very different from hospitals of today.
Back then, there were no computers, no Internet, and no automated dispensing cabinets. Handling, storage, and administration of sterile products and other medicines
were primitive compared to today. Intravenous drugs were often prepared by nurses
on the floors using less than aseptic technique. Oral medications were typically sent in
bulk bottles to nursing units to be administered with little pharmacy oversight or input.
Medication use systems were neither very safe, nor were they really systems.
Clinical pharmacy, as we now know it, was in its infancy back then. Clinical pharmacists were rarely seen in hospitals. Today’s most commonly used drugs had not yet
been invented. Major diseases including AIDS were not known either.
The hospital where my father worked was not part of an integrated health system.
The hospital did not coordinate its care with a network of outpatient clinics, physicians’
offices, pharmacy benefits management, long-term care facilities, home health agencies,
and the like. My father worked in a hospital, not a health system.
Medicare and Medicaid were just in their infancy at that time. Pharmacy benefits
managers and many other forms of managed care were virtually nonexistent. Pharmacists
were not well paid compared to the salaries given to pharmacists of today. Pharmacist
training was also different back then. Pharmacists needed fewer years of schooling and
their education revolved around the product, not the patient. In short, a lot has changed
since my father’s days.
Individuals entering the pharmacy profession today are going to see some truly
amazing changes in health care and pharmacy practice during their career. It is impossible to accurately predict what those changes will be exactly, just as it would have been
impossible for my father to imagine the changes that would occur over his lifetime. The
only certainty, however, is that change will continue. And pharmacists will be a part of
that change.
Origin of this Text
The genesis of this introductory textbook came from the Handbook of Institutional
Pharmacy Practice, first published in 1979 by Drs. Thomas Brown and Mickey Smith.
The Handbook was designed to achieve ASHP practice competencies and standards for
pharmacists and evolved as it went through four editions. The fourth edition, edited
by Thomas Brown, consists of 40 chapters covering a broad range of topics including
information systems and informatics, the integrity of the U.S. drug supply, hospice and
palliative care, and evidence-based medicine. Over the more than 30 years the Handbook
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of Institutional Pharmacy Practice has been the only text available for students and practitioners, it has documented the changes in practice that have been required for clinical
and management advancement in the profession. The text has been the one reference for
students and practitioners who wished to pursue a career in institutional pharmacy.
Many chapters from The Handbook served as the basis for this new text, Introduction to Hospital and Health-System Pharmacy Practice (HHPP). New content and pedagogy have been added to focus the content more on student needs and current practice.
The book provides learning tools for students (e.g., review questions, discussion questions, and additional reading) to assist educators in building on the text’s basic terminology and concepts.
Approach and Organization
The goal of this text has been to hone the comprehensive content presented in (HIPP)
and update it to meet the needs of current curriculums. This text has been reorganized
and presents an overview of essential terms, concepts, and processes in health-systems
pharmacy in a concise, practical, and understandable way. Content comes from recognized experts in institutional pharmacy practice. Emphasis is on explaining, developing
comprehension, and encouraging application.
The book consists of nineteen chapters divided into seven sections. The first section
answers the question, “What is Institutional Pharmacy Practice?” It provides an overview of IPP, describes its history, and discusses key legal and regulatory issues. The next
section, Managing Medication Use, describes how the medication use process is controlled through formularies, clinical pharmacy practice, and medication safety practices.
Managing Medication Distribution describes systems for managing the distribution of
medications (including controlled substances) throughout institutions. Using Technology
discusses the role of automation, technology, and information systems in health systems.
Financial Management reviews key management responsibilities of the pharmacy department including inventory control, budgeting, and cost control. Sterile Product Preparation and Administration discusses key systems, practices, and terms in preparing and administering sterile products. Managing People addresses leadership and human resources
management in institutions. Finally, Careers in Institutional Pharmacy Practice discusses
different training options for careers in health systems.
Prior knowledge of health-systems practice is not necessary to use this text, because it
is written in an easy-to-read style and provides definitions for unfamiliar vocabulary. Additionally, visual aids such as pictures, diagrams, and flow charts are provided throughout
to help explain ideas and conceptual relationships. Some of the major highlights of this
book include:
■■ Learning objectives for each chapter
■■ Key terms are highlighted and defined within chapters
■■ Definitions for key terms are listed in each chapter and summarized in a glossary
■■ Key points are highlighted and then explained by answering “so what?”
■■ Review questions are provided at the end of each chapter for self-assessment
■■ Discussion questions are provided in each chapter to initiate dialogue and debate
■■ Extensively referenced to allow further research on chapter topics
■■ Supplementary exercises which guide hands-on application of chapter content
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Intended Readers
This book is written for any pharmacy student interested in institutional pharmacy
practice. For students interested in institutional practice, this book provides a foundation
for introductory and advanced pharmacy practice experiences and on-the-job training in
hospitals and health systems. Mastery of the book’s terms and concepts will be particularly useful for students who plan to seek residencies.
The book can also be useful for students who plan to practice in community settings
by helping them understand how health systems work. Not all community pharmacists
understand institutional practice, although a general understanding of health systems
can be valuable when interacting with institutional pharmacists. Interactions often occur
as patients move in and out of hospitals and other settings. Greater contact and understanding will also be needed across practice settings if integrated therapeutic interventions such as disease management are going to succeed in achieving positive patient
outcomes.
In addition, practicing pharmacists who read this book can gain insight into institutional practice. Non-institutional pharmacists working in community settings or other
jobs will learn about the various financial, clinical, technological, and distributional
systems in health care institutions. This can be especially useful for individuals seeking a
career change, but it can be just as helpful for people who just want to understand what
goes on in a hospital or health system. Pharmacists and students from other countries
can use this book to compare how their health care systems compare with that of the
United States.
For Educators
This book can be used as the core text around which an elective or required course in
institutional pharmacy practice can be built. It can also serve as a text for the integration
of institutional pharmacy across the curriculum.
For a standalone elective or required course, educators can build learning experiences
around individual chapters. The textbook offers a selection of readings that can form the
backbone of the course. Faculty members can supplement the readings with presentations by practitioners, classroom assignments, and active learning projects. A textbook
would also help guide the presentations of different faculty involved in team-taught
courses. For instance, the first section can be used to provide an overview of health
systems and pharmacy practice within them. Faculty and guest speakers can describe
common types of institutional settings and the types of patients treated in each, discuss
pharmacist’s roles and models of practice, the history of hospital pharmacy, and the various accreditation, regulation, practice standards, and institutional policies and procedures influencing practice. Clarification of concepts within the related chapters can occur
and problem based learning activities can be used to apply and synthesize ideas covered
in the book and class.
Use of the text could also occur across the curriculum as part of integrated, multidisciplinary education. This could be accomplished by mapping institutional pharmacy
topics across curriculum, identifying the desired learning objectives for various courses,
and matching book chapters to the learning objectives. For instance, chapters from the
Managing Medication Use and Managing Medication Distribution sections of the book
could be assigned as part of hospital introductory pharmacy practice experiences (IPPEs).
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The section Sterile Product Preparation and Administration could accompany laboratory
classes that teach compounding of intravenous solutions. Financial management could
be part of a pharmacy management course, while careers in institutional pharmacy
practice could be part of career training. Students who complete all of the text’s learning
objectives would be able to have a much richer institutional advanced pharmacy practice
experiences (APPEs).
David A. Holdford, Co-Editor
Thomas R. Brown, Co-Editor
viii I n t r o d u c t i o n t o H o s p i ta l a n d H e a lt h - S y s t e m Ph a r m a c y P r a c t i c e
Contents
Preface...............................................................................................v
Contributors...................................................................................... xi
Part I: Introduction
Chapter 1: What is Institutional Pharmacy Practice?..................1
Kasey K. Thompson and Douglas J. Scheckelhoff
Chapter 2: Overview of the History of Hospital Pharmacy in the
United States.............................................................................17
William A. Zellmer
Chapter 3: Key Legal and Regulatory Issues in Institutional
Pharmacy Practice....................................................................39
John P. Uselton, Lee B. Murdaugh, Patricia C. Kienle,
and David A. Holdford
Part II: Managing Medication Use
Chapter 4: Medication Management.........................................59
Kathy A. Chase
Chapter 5: Clinical Pharmacy....................................................81
John E. Murphy
Chapter 6: Medication Safety....................................................99
David A. Holdford
Part III: Managing Medication Distribution
Chapter 7: Medication Distribution Systems...........................123
Stephen F. Eckel and Fred M. Eckel
Chapter 8: Controlled Substances Management....................143
George J. Dydek and David J. Tomich
Part IV: Using Technology
Chapter 9: Electronic Data Management:
Electronic Health-Record Systems and
Computerized Provider Order-Entry Systems.........................159
David A. Holdford, Stephen K. Huffines, and S. Trent Rosenbloom
Chapter 10: Informatics...........................................................179
James G. Stevenson, Scott R. McCreadie, and Bruce W. Chaffee
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Chapter 11: Automation in Practice........................................203
Brad Ludwig and Jack Temple
Part V: Financial Management
Chapter 12: Purchasing and Inventory Control.......................229
Jerrod Milton
Chapter 13: Basics of Financial Management and
Cost Control............................................................................253
Andrew L. Wilson
Part VI: Sterile Product Preparation and Administration
Chapter 14: Sterile Preparations and
Admixture Programs................................................................277
Philip J. Schneider and E. Clyde Buchanan
Chapter 15: Parenteral Therapy..............................................299
E. Clyde Buchanan
Part VII: Managing People
Chapter 16: Leadership and Management..............................321
David A. Holdford
Chapter 17: Recruiting, Selecting, and Managing Pharmacy
Personnel ............................................................................345
David A. Holdford
Part VIII: Careers in Institutional Pharmacy Practice
Chapter 18: Training for Careers in Hospitals and Health
Systems ............................................................................367
Thomas P. Reinders and David A. Holdford
Chapter 19: Residency Training..............................................383
Jill S. Burkiewicz and Carrie A. Sincak
Index...............................................................................................399
Contributors
E. Clyde Buchanan,
M.S., FASHP
Director of Pharmacy (Ret.)
Consultant specializing
in compounding sterile
preparations
Atlanta, Georgia
Jill S. Burkiewicz,
Pharm.D., BCPS
Professor & PGY1 Residency
Director, Pharmacy Practice
Midwestern University Chicago
College of Pharmacy
Downers Grove, Illinois
Bruce W. Chaffee,
Pharm.D.
Clinical Pharmacist and Clinical
Associate Professor
Informatics and Outcomes
College of Pharmacy
The University of Michigan
Health System
Ann Arbor, Michigan
Kathy A. Chase,
Pharm.D.
Director, Medication Solutions
Cardinal Health
Houston, Texas
George J. Dydek,
Pharm.D., BCPS,
FASHP, CACP
Clinical Pharmacist
Family Medicine Clinic
Madigan Army Medical Center
Tacoma, Washington
Fred M. Eckel, M.S.,
FASHP, FAAAS, DNAP
Professor of Pharmacy
Eshelman School of Pharmacy
University of North Carolina at
Chapel Hill
Executive Director
NC Association of Pharmacists
Chapel Hill, North Carolina
Stephen F. Eckel,
Pharm.D., MHA,
BCPS, FAPhA
Assistant Director of Pharmacy,
Residency Program Director
University of North Carolina
Hospitals
Clinical Assistant Professor
Eshelman School of Pharmacy
University of North Carolina
Chapel Hill, North Carolina
David A. Holdford,
R.Ph., M.S., Ph.D.,
FAPhA
Associate Professor
Department of Pharmacotherapy
and Outcomes Science
Virginia Commonwealth
University School of
Pharmacy
Richmond, Virginia
Stephen K. Huffines,
Pharm. D.
Scott R. McCreadie
Pharm.D., MBA
President
McCreadie Group
Ann Arbor, Michigan
Jerrod Milton, BSc
Pharm., R.Ph.
Vice President, Operations
Children’s Hospital
Aurora, Colorado
Lee B. Murdaugh, R.Ph.,
Ph.D.
Director, Accreditation and
Medication Safety
Quality and Regulatory Affairs
Cardinal Health Pharmacy
Solutions
Houston, Texas
John E. Murphy,
Pharm.D., FASHP,
FCCP
Director, Pharmacy Business
Services
Vanderbilt University Medical
Center
Nashville, Tennessee
Professor of Pharmacy Practice
and Science
Associate Dean
The University of Arizona
College of Pharmacy
Tucson, Arizona
Patricia C. Kienle,
R.Ph., MPA, FASHP
Thomas P. Reinders,
Pharm.D.
Director, Accreditation and
Medication Safety
Cardinal Health Pharmacy
Solutions
Laflin, Pennsylvania
Associate Dean for Admission
and Student Services
School of Pharmacy
Virginia Commonwealth
University
Richmond, Virginia
Brad Ludwig, M.S.,
R.Ph.
Assistant Director of Pharmacy
Operations/Technology
University of Wisconsin Hospital
and Clinics
Madison, Wisconsin
S. Trent Rosenbloom,
MD, MPH
Assistant Professor of
Biomedical Informatics,
Medicine and Pediatrics
Vanderbilt University Medical
Center
Nashville, Tennessee
I n t r o d u c t i o n t o H o s p i ta l a n d H e a lt h - S y s t e m Ph a r m a c y P r a c t i c e xi
Douglas J.
Scheckelhoff, M.S.
James G. Stevenson,
Pharm.D., FASHP
David J. Tomich,
Pharm.D., FASHP
Vice President, Professional
Development
American Society of HealthSystem Pharmacists®
Bethesda, Maryland
Professor and Associate Dean
for Clinical Sciences
University of Michigan College of
Pharmacy
Director of Pharmacy Services
University of Michigan Health
System
Ann Arbor, Michigan
Chief Clinical Pharmacy Services
Madigan Army Medical Center
Tacoma, Washington
Philip J. Schneider, M.S.
Clinical Professor and Associate
Dean
University of Arizona College of
Pharmacy
Phoenix, Arizona
Carrie A. Sincak,
Pharm.D., BCPS
Associate Professor and Vice
Chair of Acute Care
Department of Pharmacy
Practice
Midwestern University Chicago
College of Pharmacy
Downers Grove, Illinois
xii Jack Temple, M.S.,
Pharm.D.
Pharmacy Manager Operational
Improvement
University of Wisconsin Hospital
and Clinics
Madison, Wisconsin
Kasey K. Thompson,
Pharm. D.
Vice President, Office of
Policy, Planning and
Communications
American Society of HealthSystem Pharmacists
Bethesda, Maryland
John P. Uselton, R.Ph.
Vice President
Quality and Regulatory Affairs
Cardinal Health Pharmacy
Solutions
Houston, Texas
Andrew L. Wilson,
Pharm.D., FASHP
Managing Consultant, Pharmacy
Optimization
McKesson Health Systems
Richmond, Virginia
William A. Zellmer, B.S.
(Pharmacy), MPH
Independent consultant and
speaker on strategic and
professional issues in
pharmacy
Bethesda, Maryland
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